Oral Cancer

All cancers occurring in the lip, tongue, hard palate, floor of the mouth, retromolar region (20-year-old tooth region) and buccal mucosa (cheek) are considered as “oral cancer” (oral cancer). While the behavior of each of these cancers is very different, they are all types of aggressive cancer.

What is Oral Cancer?

Oral cancer is abnormal cell growth anywhere in the mouth or lips. While catching oral cancers as early as possible is extremely important for the success rate of treatment, surgery comes to the fore in the treatment of tumors in this region. Surgery should be performed as wide and safe as possible, leaving the surgical margin, and the surgical area removed during the operation should be supported by pathology. In some cases, chemotherapy may be used in addition to surgery. Neck dissection should be done in the treatment of a cancer in the mouth. (except hard palate)

What are the Risk Factors in Oral Cancer?

The risk of oral cancer increases in long-term and heavy users of tobacco and tobacco products, in fact, it has been determined that approximately 75 percent of people with oral cancer use tobacco. As the amount and duration of tobacco use increases, the risk of oral cancer also increases. Excessive alcohol consumption, too much exposure to the sun, being over 40 years old, being obese are also among the factors that increase the risk of oral cancer. People with a history of head and neck cancer have an increased risk of developing mouth cancer, especially if they continue to smoke and drink alcohol. In addition, having certain health problems such as HPV infection, ultraviolet rays, malnutrition, weakened immune system, graft-versus-host disease or fanconi anemia, and poor oral hygiene also increase the risk of oral cancer.

Note: Those with oral cancer are more likely to develop cancer of the larynx, esophagus or lung.

What Are the Types of Oral Cancer?

Oral cancer is categorized by the type of cell in which the cancer (carcinoma) begins to grow, squamous cell carcinoma being the most common type of oral cancer accounting for 9 out of 10 cases.

Less common types of oral cancer include:

• Adenocarcinoma, which are cancers that develop inside the salivary glands
• Sarcoma growing from abnormalities in bone, cartilage, muscle, or other tissues
• Oral malignant melanoma, in which cancer begins in the cells that produce skin pigment or color (melanocytes). These appear as very dark, mottled bumps that often bleed.

Lymphoma that usually develops from cells found in lymph nodes. (They can also grow in the mouth.)

Oral cancer, on the other hand, is a type of cancer called ‘head and neck cancers’. Other types of head and neck cancer include:

• Throat cancer
• Nasopharyngeal cancer (the area behind the nose that forms the upper part of the throat (pharynx)
• Oropharyngeal cancer
• Hypopharyngeal cancer
• thyroid gland cancer
• Nose and sinus tumors
• Esophageal cancer

What are the Causes of Oral Cancer?

Oral cancer occurs when cells in the lip or mouth develop changes (mutations) in their DNA. A cell’s DNA contains information that tells the cell what to do. The mutation tells cells that they must continue to grow and divide at the same time that healthy cells should die. Accumulating abnormal cancer cells can take the form of a tumor, and over time there is a possibility of spreading into the mouth and other areas of the head and neck region or to other parts of the body.

Oral cancer generally starts in the flat and thin cells (squamous cell) lining the lips and mouth, most of the oral cancers are squamous cell carcinomas.

It is not clear why the mutations in squamous cells that lead to oral cancer occur, but doctors have identified elements that may increase the risk of oral cancer.

How Is Oral Cancer Diagnosed?

The diagnosis process in oral cancer begins with a physical examination. In a routine check-up, the dentist may feel any lump or mass, noticing an abnormal tissue change in the mouth, with or without symptoms.

A direct examination of the lesion or a small biopsy can make the diagnosis. Once diagnosed, the doctor will use various tests to determine whether the cancer has spread beyond the oral cavity, the extent of the cancer, and may include:

• MRI scan of the head and neck
• CT scan of the chest to look for cancer in the lymph nodes
• Positron Emission Tomography (PET) scan to look for cancer in other parts of the body
• The doctor may also look at the larynx, esophagus, and lungs by sliding a tube with a small camera at the end down the throat.

How Is Oral Cancer Treatment?

Oral cancer treatment procedures may vary depending on the general health status of the patient, the location and stage of the cancer. The most common treatment for oral cancer is a surgical procedure. It involves removing the tumor and some healthy tissue around it. When cancer cells spread to the lymph nodes,

When cancer cells have spread to the lymph nodes, the surgeon removes them to prevent the cancer from spreading to other parts of the body. One of the most exciting and pervasive new developments in the treatment of oral cancer is the use of robotic surgery.

Radiotherapy is the primary treatment for a number of small tumors, using high-energy x-rays to kill cancer cells. In some cases, patients undergoing surgery are given radiotherapy to remove cancer cells that may remain at the microscope level in the body after surgery. Even when it cannot cure the cancer, radiotherapy can relieve symptoms such as bleeding and difficulty swallowing.

Physicians may apply chemotherapy to shrink tumors before a surgical procedure if needed, and when the tumor is too large to be operated on, chemotherapy and radiotherapy can relieve symptoms caused by cancer.

If the cancer is diagnosed at an earlier stage (Stages I and II), the chances of recovery are much higher because tumors at these stages are smaller than 4 centimeters at their widest point and have not spread to the lymph nodes. It is possible to treat cancer patients in these stages with surgical procedures and radiotherapy. Stage III and IV tumors are more advanced, at these stages the tumors are treated with radiotherapy, chemotherapy, or both, in addition to more extensive surgical procedures. Targeted drug therapy can also be administered alone or in combination with chemotherapy-radiotherapy.

In immunotherapy, drugs are given to help the immune system fight cancer. Immunotherapy can be applied to patients with advanced oral cancer that does not respond to standard treatments.

What are the Ways of Prevention of Oral Cancer?

There is no proven way to prevent oral cancer, but you can reduce the risk of oral cancer by applying the following:

Never start using tobacco, if you do, quit. Tobacco use, whether in the form of smoking or chewing, will expose the cells in your mouth to dangerous chemicals that cause cancer.

If you drink alcohol, be in moderation. Long-term excessive use of alcohol can irritate the cells in the mouth and predispose them to oral cancer. For healthy adults, this means not exceeding one drink per day for women of all ages and men over 65, and 2 drinks per day for men under 65.

Protect your lips from excessive sun exposure. Prefer to stay in the shade to protect the skin on your lips from the sun as much as possible. Wear a wide-brimmed hat that covers your entire face, including the brim, and apply a sunscreen lip product as part of your sun protection routine.

See the dentist regularly. As part of a routine dental exam, ask your dentist to inspect your entire mouth and abnormal areas for precancerous changes and any signs of oral cancer.

How Can Oral Cancer Risk Be Reduced?

A well-rounded, healthy diet with a variety of fruits and vegetables can also reduce the risk of oral cancer.

What is Supportive Care for Oral Cancer?

Supportive care helps with the physical, practical, emotional and spiritual challenges of oral cancer. There are many programs and services that help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment.

The process of getting rid of oral cancer and getting used to life after treatment is different for each individual, depending on the location of the tumor, the stage of the cancer, the organs and tissues removed during the surgery, and the type of treatment. Even after treatment has ended, problems such as coping with long-term side effects may occur and the person being treated for oral cancer may have the following concerns.

Self-Esteem and Body Image

Self-confidence can be defined as how a person feels himself. Body image is how an individual sees his or her body, oral cancer and its treatments can affect a person’s self-confidence and body image. This is usually due to the following factors:

• Scars
• Skin changes
• Changes in face shape
• Having to use a prosthesis
• Difficulty speaking or eating
• Weight loss
• Some of these changes may be temporary, while others may persist for a long time or become permanent.

Some people may avoid socializing even if the effects of treatment are not visible outside the body. because they may fear that others will judge them, and may be afraid of experiencing a sad and angry emotional hit.

Those whose appearance is affected after oral cancer surgery should give themselves time. Talking to someone who has had a similar experience, family support, socializing with friends can help the individual. There are also tools that can help with facial changes, such as camouflage makeup for scars or wearing scarves and hats.

Dry Mouth

It is natural for many people to experience dry mouth during and after oral cancer treatment. Radiotherapy or a surgical procedure that damages the salivary glands can cause dry mouth. Chemotherapy given with radiotherapy can also exacerbate dry mouth, and intensity-modulated radiotherapy (IMRT) can help reduce this complication in many patients.

Chewing and Swallowing Difficulties

Oral surgery: especially if it involves the removal of certain structures such as the tongue and jawbone, this can lead to difficulties in chewing and swallowing. In some cases, a reconstruction or dental prosthesis may be needed to change a structure inside the mouth. Ways to improve swallowing include changing your head posture and doing range-of-motion exercises for the jaw and tongue. The feeding device, called the glossectomy spoon, allows the person to place soft food at the back of the mouth, which aids in swallowing.

Speech Problems

Surgery to remove large parts of the tongue, jawbones, or palate can cause speech problems. Restructuring helps reduce these complications, but restoring normal function is often difficult. At this point, oral prostheses can help compensate for the tissue lost during surgery and improve speech.

A speech therapist can evaluate speech problems and help manage them.

Taste Changes

It is possible for radiotherapy to the head, neck, or mouth to damage the salivary glands and taste buds on the tongue, which can affect the way some foods taste. In addition, it is possible that chemotherapy drugs can affect taste cells in the mouth. Surgery to remove part or all of the tongue may result in decreased or loss of the sense of taste.

Dental Problems

Radiotherapy can cause dental problems. Saliva helps clean teeth and gums, so when less saliva is produced, the risk of developing cavities and gum disease increases. Radiotherapy can also affect tooth enamel, increasing the risk of tooth decay.

Good oral care is very important to prevent problems, so a check-up can be made at the dentist before the treatment starts, and fluoride treatments can be applied to prevent the formation of caries on the teeth. After the treatment, it is necessary to go to the dentist regularly.

Nutritional Problems

Chewing, difficulty swallowing, loss of appetite and malnutrition can lead to weight loss. Steps can be taken to increase appetite and help people eat more and maintain good nutrition, and nutritional supplements may be recommended. A registered dietitian can often help people manage their diet and appetite.

Decreased Thyroid Function (Hypothyroidism)

Between 30 percent and 40 percent of people who receive radiotherapy for head and neck cancers, including mouth cancer, will develop hypothyroidism. Some symptoms of hypothyroidism are extreme fatigue, dry skin and hair loss, weight gain, and intolerance to cold.

After oral cancer treatment, those with hypothyroidism problems may need daily medication.